PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Stage shift”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 181 records · Page 10Linked to original sources
PubMed2003

[Changes and complication rate in surgery for thoracic esophageal carcinoma].

AIM: In an analysis over 22 years it was investigated which parameters have changed in the operative treatment of thoracic esophageal carcinoma over time and in how far they have influenced complication rate. PATIENTS AND METHODS: Between 1978 and 1999 386 patients (350 men, 36 women) underwent resection for thoracic esophageal carcinoma (squamous cell carcinoma n=300, adenocarcinoma n=86). Cervical tumors were excluded from analysis. The time periods from 1978 to 1988 (n=242) and from 1989 to 1999 (n=144) were separately analyzed and compared with respect to age, sex, histological type, main tumor location, neoadjuvant therapy, method of operation, esophageal substitute and positioning of the substitute, R-status, pT/pN classification, UICC stage, number of dissected lymph nodes, complication rate, postoperative mortality and survival. RESULTS: Comparison of the two time periods showed a significant increase in adenocarcinomas and main tumor location in the lower thoracic third of the esophagus. Furthermore, significant changes concerning the indication of neoadjuvant chemoradiation, operative approach, esophageal substitute, R-status and number of dissected lymph nodes were observed. Tumor stage (pT/pN classification and UICC stage) significantly shifted towards earlier stages. Total complication rate dropped tendentially form 68.5 % to 59.0 % (p=0.061). Hospital mortality was significantly reduced from 24 % to 12.5 %, whereas anastomotic leakages and multiorgan failure remained on a constant level. Median survival of R0 resected patients was significantly prolonged from 19 months to 34 months. CONCLUSIONS: The increase of esophageal adenocarcinoma, a more strict patient selection (staging, functional status), standardization of operative technique as well as an optimized intensive care management are among the important changes in the operative management of thoracic esophageal carcinoma that have resulted in an improvement of prognosis of curatively resected patients. In spite of a more aggressive operative approach, i. e. lymph node dissection, operative mortality could be reduced by nearly 50 % in the face of a tendentially declining total complication rate.

Adenocarcinoma↗
PubMedDate not supplied

Longitudinal shifts in employees' stages and processes of exercise behavior change.

PURPOSE: This study examines the usefulness of using the stages and processes of change model to explore exercise adoption and maintenance over time. DESIGN: Data for this study were collected as part of the baseline and follow-up survey of participants in a worksite health promotion project. SUBJECTS: Three hundred fourteen employees completed exercise questionnaires. The average age was 41 years, mean body mass index was 26, average years of education were 13, and 66% were women. SETTING: The study was conducted in two worksites, a retail outlet and a manufacturing company. MEASURES: Previously validated questionnaires to determine stages and processes of exercise adoption were administered at baseline and 6-month follow-up, along with questions about demographic variables. RESULTS: Four patterns of stage change emerged: subjects who became more active (adopters, 26%), those who became less active (relapsers, 15%), and those who did not change over time (stable sedentary, 32%; stable active, 27%). Adopters displayed increases in use of the processes of change, whereas relapsers displayed decreases in process use. Stable profiles were associated with no change in process use. CONCLUSIONS: These findings have important implications for research on exercise adoption and maintenance. Interventions tailored specifically to subjects' stage of readiness to be active and using specific processes to help in the change process are warranted at this time.

Adult↗
PubMed2002

Modeling the impact of the decline in distant stage disease on prostate carcinoma mortality rates.

BACKGROUND: The incidence of distant stage prostate carcinoma was relatively flat until 1991 and then started declining rapidly. This decline probably was caused by the shift to earlier stage disease associated with the rapid dissemination of prostate specific antigen (PSA) screening. Prostate carcinoma mortality rates started falling at approximately the same time. In this article, the authors model the potential impact of this stage shift on prostate carcinoma mortality rates given various assumptions concerning the survival of patients with screen-detected local-regional disease. METHODS: The authors used the CAN*TROL 2 computer model to shift each deficit in the number of patients with distant stage disease to local-regional stage disease and modeled the implications on mortality using a set of base, optimistic, and pessimistic survival assumptions. A base survival assumes that a patient with screen-detected local-regional disease of a certain histologic grade has the same prognosis as a patient with clinically detected local-regional disease of same grade (i.e., an assumption of no length bias for patients with screen-detected disease), whereas the optimistic and pessimistic scenarios assume that survival is better or worse, respectively, than the base survival (i.e., complete cure for patients with favorable grade for the optimistic scenario and no improvements in survival for patients with unfavorable grade for the pessimistic scenario). RESULTS: Model results were compared with observed mortality trends. Rising age-adjusted mortality rates peaked in 1991 for white males and in 1993 for black males and then fell 21% and 13% for white males and black males, respectively, from 1990 through 1999. Under the modeled stage-shift intervention, mortality rates would fall 18%, 8%, and 19% for both white males and black males under the base, pessimistic, and optimistic assumptions, respectively. CONCLUSIONS: It is impossible to know what the mortality trends would have been in the absence of the introduction of PSA screening. However, under the base assumption, it appears that the decline in distant stage disease can have a fairly sizable and rapid impact on population mortality. The optimistic scenario is not much improved over the base scenario, which is indicative of the facts that the survival of patients diagnosed with clinical local-regional prostate carcinoma is quite good and that further survival improvements can have only a marginal impact. Under the pessimistic scenario, it appears that something else must be responsible for much of the decline in mortality. Screening trial results from the United States and Europe may verify and isolate the size of any mortality benefit associated with PSA screening. Trial results eventually can be put back into these population models to help quantify the impact of screening, treatment, and other factors on population trends.

Computer Simulation↗
PubMed1995

Aromatase activity in larval gonads of Pleurodeles waltl (Urodele Amphibia) during normal sex differentiation and during sex reversal by thermal treatment effect.

Estrogens are involved in gonadal differentiation in birds and in reptiles with temperature-dependent sex determination, suggesting a key role for aromatase, the enzyme complex converting androgens to estrogens. Pleurodeles waltl is an amphibian with ZZ/ZW genotypic sex determination but gonadal differentiation is thermosensitive. The sexual phenotype is in conformity with the sexual genotype at ambient temperature (20 +/- 2 degrees), but ZW animals are sex-reversed in functional males when larvae are reared at 32 degrees from stage 42 to stage 54 (thermosensitive period). Histological sexual differentiation of gonads begins at stage 53. Aromatase activity was measured either in the gonadmesonephric complexes (stages 47 to 52) or in the gonads (stages 53 to 56) of ZZ and ZW larvae reared at ambient temperature or at 32 degrees and of ZW larvae shifted at stages 53, 55, or 56 from ambient temperature to 32 degrees for 48 hr. At ambient temperature, aromatase activity was detected, at low levels, in gonad-mesonephric complexes of both ZZ and ZW larvae at stages 47 and 50. At stage 52, it was significantly higher in ZW individuals than in ZZ ones. Then it remained low in gonads of ZZ males, whereas it markedly increased in gonads of ZW females. At 32 degrees, the gonad-mesonephric complexes (stage 52) and the gonads (stages 53 to 56) of ZW larvae had low aromatase activity similar to that in ZZ individuals. The exposure to 32 degrees for 48 hr of ZW individuals significantly decreased gonadal aromatase activity during the thermosensitive period (shift at stage 53) but not after the thermosensitive period (shifts at stages 55 and 56).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Secular trends in the incidence of female breast cancer in the United States, 1973-1998.

Statistical modeling suggests a causal association between the rapid increase in the incidence of female breast cancer (FBC) in the United States and the widespread use of screening mammography. Additional support for this suggestion is a shift in the stage at diagnosis that consists of an increase in early stage diagnosis followed by a decrease in late-stage diagnosis. This has not been reported in the United States. The objective of this study was to examine the secular trends in the incidence of FBC in search of empirical support for this shift. FBC cases in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 through 1998 were dichotomized into early and late detection based. Early detection included all the in situ and invasive cases with local spread. Late detection included cases with regional spread and distant metastasis. Joinpoint segmented regression modeling was used for trend analysis. Early detection in white and black women followed a similar pattern of significant increase in the early 1980s that continued through 1998 with slight modification in 1987. The expected shift in stage was noticed only for white women when the incidence of late detection in them began to decline in 1987. The incidence of late detection in black women has remained stable. These results provide further support for the previously implied causal association between the use of screening mammography and the increased incidence of FBC in the United States. It also shows that the expected stage shift appeared in white women 50-69 years of age after an estimated detection lead time (DLT) of about 5 years. This is the first estimate of DLT in the United States that is based on actual data. The subsequent increase in late detection in white women since 1993 may be due to changes in case management and the increased use of sentinel lymph node biopsy (SLNB) rather than changes in the etiology or biology of FBC.

Adult↗
PubMed2005

Mixing costs in task shifting reflect sequential processing stages in a multicomponent task.

We investigated the hypothesis that mixing costs intask shifting reflect th e sequential selection of task components (e.g., stimulus categories) during task execution. This proposition was supported by Hübner, Futterer, and Steinhauser (2001), who showed that the amount of mixing costsdepends on the number of mixed task components (e.g., stimulus level and judgment). However, their results could also be explained by a task set selection account, because task components and task sets were confounded. In Experiments 1 and 2, we compared conditions in which either the number of task sets varied and the number of mixed task components was constant or vice versa. Only the number of mixed task components was predictive for the mixing costs. In Experiment 3, we replicated the additivity of mixing costs from level a ndjudgment mixing. Our results suggest thatthe mixingcosts reflect a selection strategy in which interference is reduced in a stepwise manner.

Adolescent↗
PubMed2006

The cell type-specific signal proteins (pheromones) of protozoan ciliates.

In association with their mechanisms of self/non-self recognition (known as mating type systems), ciliates synthesize and constitutively secrete cell type-specific proteins into their extracellular medium. These proteins, designated as pheromones, have been isolated from species of Euplotes and shown to be members of families of structurally homologous molecules, all rich in intra-chain disulfide bonds and organized exclusively in helical conformation. Due to their similar architectures, they can interact with their membrane receptors in competition with one another and bind effectively to their cells of origin in autocrine fashion, or to other co-specific cells in paracrine fashion. In the former case, they promote the vegetative cell growth; in the latter, they induce cells to temporarily arrest their growth stage and shift to a mating (sexual) stage. These varied, context-dependent activities of ciliate pheromones imply an early evolution of basic properties of animal growth factors and cytokines in the unicellular eukaryotes.

Animals↗
PubMed1985

Stomach cancer: major trends in incidence during introduction of gastroscopy service in Norway.

The age-adjusted incidence of stomach cancer has been studied during the introduction of gastroscopy service in Norway. The incidence showed an annual decrease of 3.5% for both sexes. More cases were classified within anatomic subsites. For men there was a decreasing incidence for cancers located in the antrum, for extensive tumours and for not otherwise specified (NOS) disease. No significant changes were found for cancer of the body or the cardia/fundus. In women a decrease in incidence was noted for the NOS subgroup, an increase was seen for tumours of the gastric body, and no significant changes were found for antral cancers or for tumours of the cardia/fundus. A marked increase in incidence was noted for gastric stump cancers for both sexes. During this period a shift in staging towards less advanced disease occurred. In conclusion, the increased diagnostic accuracy and the shift in staging of the disease may suggest that the introduction of gastroscopy service has been effective.

Adult↗
PubMed2004

Effect of temperature on batch elastase production by Bacillus sp. EL31410.

The production of elastase by Bacillus sp. EL31410 at various temperatures was investigated. In order to study the effect of temperature on elastase fermentation, different cultivation temperatures, ranging from 39 degrees C to 28 degrees C, were evaluated in shake flask. The result indicated that 37 degrees C was best for cell growth at earlier stage; while maximum elastase activity was obtained when the cells were cultivated at 30 degrees C. This result was verified by batch fermentation in 5-L bioreactor under 37 degrees C and 30 degrees C temperature, respectively. The specific cell growth rate at 37 degrees C was higher than that at 30 degrees C during earlier stage of cultivation. The maximum value [5.5 U/(h x g DCW)] of elastase formation rate occurred at 24 h at 30 degrees C compared to 4.6 U/(h x g DCW) at 30 h at 37 degrees C. Based on these results, two-stage temperature shift strategy and oscillatory temperature cultivation mode were evaluated in the next study. When compared to single temperature of 37 degrees C or 30 degrees C, both two-stage temperature shift strategy and oscillatory temperature strategy improved biomass but did not yield the same result as expected for elastase production. The maximum biomass (both 8.6 g/L) was achieved at 30 h at 37 degrees C, but at 42 h using two-stage temperature cultivation strategy. The highest elastase production (652 U/ml) was observed at 30 degrees C in batch process. It was concluded that cultivation at constant temperature of 30 degrees C was appropriate for elastase production by Bacillus sp. EL31410.

Bacillus↗
PubMed1997

Prostate carcinoma incidence and patient mortality: the effects of screening and early detection.

BACKGROUND: Screening for and the aggressive treatment of prostate carcinoma are controversial, but they are nevertheless being practiced in the U.S. Current clinical studies of the effectiveness of screening will take years to complete. Meanwhile, screening for prostate carcinoma is already having an effect on society. METHODS: National and regional trends in prostate carcinoma incidence and data on patient mortality and survival from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute are described in this article. SEER is a population-based cancer data base comprised of nine discrete areas. Fundamental principles of screening are used in this article to explain the impact that prostate carcinoma screening has had in the U.S. RESULTS: According to the data in the SEER registries, overall prostate carcinoma incidence rates increased at a far greater pace than prostate carcinoma mortality rates during the period 1973-1994. During that period, there was a shift in stage at diagnosis characterized by an increase in local and regional disease, and a decline in distant disease at diagnosis. Overall 5-year survival rates for prostate carcinoma patients also increased. The increase in incidence rates, the shift in stage at diagnosis, and the increase in survival rates are all evidence of increasing early detection. However, these changes are consistent with lead-time bias, length bias, a decline in mortality, and all three could have occurred. In the geographic SEER registries, the prostate carcinoma incidence rates vary markedly. These variations in incidence rates are due to regional variations in practice patterns and screening efforts. On the other hand, the SEER registries have comparable mortality rates. This is evidence of both lead-time bias and length bias. CONCLUSIONS: Substantial regional variations in incidence were found, but regional mortality rates were similar. This is evidence that screening and early detection efforts are resulting in the diagnosis of prostate carcinoma in some men who do not need therapy; thus, prostate carcinoma screening can lead to unnecessary treatment for such men. Furthermore, epidemiologic data do not demonstrate that screening is decreasing mortality. The benefits of screening and early detection, although theoretically possible, are yet unproven, whereas the risks and harms of screening and resultant treatment are definite.

Humans↗
PubMed2001

Trends in breast cancer mortality, incidence, and survival, and mammographic screening in Tuscany, Italy.

OBJECTIVE: The study describes breast cancer mortality trends in Tuscany (period 1970-97), comparing Florence with the rest of Tuscany (Florence excluded), and, for Florence, incidence (period 1985-94) and survival (1985-86 versus 1991-92) trends, taking into account the diffusion of screening. METHODS: Mortality and incidence rates, age-adjusted on the European population, and 95% confidence intervals (95% CI). Five-year relative survival rates and estimates of risk of dying provided by the Cox model. RESULTS: Mammographic screening, started at the beginning of the 1970s in some municipalities, largely involved the Florence area after 1990 (mammograms/years: from 8,000-9,000 to 28,000-29,000, respectively, before and after 1990). In the same period no population-based screenings were ongoing in the rest of Tuscany. A significant mortality drop was observed in Tuscany (-3.7%/year), starting at the beginning of the 1990s and observed for ages < or = 74 (especially ages 40-49: -11.2%/year). The drop was similar in Florence and in the rest of Tuscany. In ages 50-69, incidence, increasing between 1985-87 and 1988-90 (+6.5%), rose sharply in 1991-94 (+17.0%); it was stable in other ages. Local disease increased more markedly in ages 50-69 (globally: +88.3%), but also in other ages (+20-30%). Regional and metastatic cancers decreased. A significantly better 5-year survival was observed among cases diagnosed in 1991-92, persisting after adjustment by extent of disease. CONCLUSION: Even if the causes of breast cancer mortality trends are not easy to clarify in an observational study. our data suggest that the drop in mortality observed in Tuscany at the beginning of the 1990s could be largely explained by both earlier detection, outside of an organized screening program, and by better treatments. The increase in incidence and the shift in stage distribution that occurred before the enlargement of the screening area and in age groups not involved in the program, supports the role of a 'spontaneous' widespread earlier detection. The better survival of the period 1991-92, only partly explained by the shift in stage at diagnosis, indirectly supports the role of improvement in therapy.

Adult↗
PubMed1987

Monoclonal antibodies against Drosophila ovaries: their reaction with ovarian and embryonic antigens.

A library of monoclonal antibodies (MAbs) against Drosophila ovarian antigens was established. Each of the MAbs was characterized by its immunohistochemical binding pattern to sections from egg chambers at various stages of oogenesis. Sixteen of the 18 MAbs were found to bind to antigens in mature oocytes. Among the 16 antigens, two were also located in cytoplasm of cell types in the egg chamber other than the oocyte, at all stages of oogenesis. Four made their appearance in nurse cell cytoplasm at mid-vitellogenic stages and shifted to oocyte cytoplasm at a later stage, and ten appeared at the vitellogenic stage and confined their distribution to oocyte cytoplasm. All these antigens were distributed evenly in cytoplasm of mature oocytes. However, some of these antigens were noticed to change their distribution during early embryogenesis as to be localized in a specific region of embryos.

Animals↗
PubMed2025

The Application of Preventive Medicine in the Future Digital Health Era.

A number of seismic shifts are expected to reshape the future of medicine. The global population is rapidly aging, significantly impacting the global disease burden. Medicine is undergoing a paradigm shift, defining and diagnosing diseases at earlier stages and shifting the health care focus from treating diseases to preventing them. The application and purview of digital medicine are expected to broaden significantly. Furthermore, the COVID-19 pandemic has further accelerated the shift toward predictive, preventive, personalized, and participatory (P4) medicine, and has identified health care accessibility, affordability, and patient empowerment as core values in the future digital health era. This "left shift" toward preventive care is anticipated to redefine health care, emphasizing health promotion over disease treatment. In the future, the traditional triad of preventive medicine-primary, secondary, and tertiary prevention-will be realized with technologies such as genomics, artificial intelligence, bioengineering and wearable devices, and telemedicine. Breast cancer and diabetes serve as case studies to demonstrate how these technologies such as personalized risk assessment, artificial intelligence-assisted and app-based technologies, have been developed and commercialized to provide personalized preventive care, identifying those at a higher risk and providing instructions and interventions for healthier lifestyles and improved quality of life. Overall, preventive medicine and the use of advanced technology will hold great potential for improving health care outcomes in the future.

Humans↗
PubMed1975

[Peripheral arterial disease and diabetes mellitus(author's transl)].

Among a group of 286 patients with atherosclerotic arterial disease 35.3% had normal carbohydrate tolerance, 28% asymptomatic (biochemical or latent), and 36.7% overt diabetes mellitus. There was a tendency towards peripheral artery involvement and a greater incidence of coronary heart disease (myocardial infarction, changes in ST-T segment) among patients with asymptomatic or overt diabetes, figures being comparable for men and women. Most of the patients with atherosclerotic arterial disease without diabetes mellitus were in stage II, while in diabetics there was a shift towards stages I and IV. There was no significant correlation between incidence, symptoms, and location of atherosclerotic arterial disease, on the one hand, and duration of overt diabetes, on the other.

Arterial Occlusive Diseases↗
PubMed1996

Angiographic analysis of moyamoya disease--how does moyamoya disease progress?

Differences in the clinical presentation and angiographic stages of moyamoya disease were studied in 69 patients, 35 children (6.3 +/- 2.9 years old) and 34 adults (44.6 +/- 10.5 years old). The angiographic stage (Suzuki's stage) was compared between childhood and adulthood, ischemic onset and hemorrhagic onset, and female and male. The distribution of the angiographic stage was not very different, but was significantly shifted from stage III to stage IV in adult cases. The angiographic stage in patients with hemorrhagic onset was not significantly different from those with ischemic onset. There was no significant difference between females and males. Angiographic change is not very remarkable between pediatric and adult moyamoya disease. The angiographic stage does not directly correlate with the distinct clinical presentations between pediatric and adult moyamoya disease. Other factors such as cerebral blood flow demand and arteriosclerotic change seem to cause these differences.

Adolescent↗
PubMed2000

EST sequencing of the parasitic nematode Haemonchus contortus suggests a shift in gene expression during transition to the parasitic stages.

Expressed sequence tags from the parasitic nematode Haemonchus contortus were generated in order to identify anchor loci for comparative mapping between nematode genomes and candidate targets for future control measures. In total, 370 SL1 trans-spliced cDNAs from different developmental stages representing 195 different genes were partially sequenced. From these expressed sequence tags 50% were similar to genes with a known or predicted function and 19% were similar to nematode sequences with no ascribed function. From the first, free-living L1 and L3 stages relatively many cDNAs matched to housekeeping genes, and 11% (L1) or 23% (L3) of the encoded proteins were predicted to contain signal peptides. In contrast, no function could be ascribed to most of the cDNAs from the early L5 and adult parasitic stages, but for 30% (L5) or 55% (adult) of the encoded proteins a signal sequence was predicted. This limited analysis suggests that during the transition from the free-living to parasitic stages gene expression shifts towards the synthesis of less conserved extracellular proteins. These proteins offer the best perspectives for vaccine development and the development of anthelmintic drugs. In contrast, cDNAs from the first larval stages may be most suitable for comparative mapping with the free-living nematode Caenorhabditis elegans.

Animals↗